TORONTO — Experts warn that delays in frontline care and a messy transition are real threats to the Ford government’s plans for a health care “super agency” — but the minister maintains Ontario won’t fall victim to the chaos that befell other provinces.

In its current form, the bill sets the table for the amalgamation of the province’s 14 local health integration networks (LHIN) into one super agency that could also swallow up agencies like Cancer Care Ontario and eHealth Ontario. The centralized organization is part of the government’s plan to tackle hallway health care and improve patient care, according to Elliott.

“Making sure that there are more frontline services and programs for people is what makes an excellent quality health care system and that’s what we are committed to delivering,” Elliott told iPolitics.

“It’s not about bureaucracy,” she maintained, “it’s about the people and what their needs are.”

While cautioning that the legislation is still under development, Elliott repeatedly defended the super agency against concerns raised most prominently by Ontario’s former deputy minister of health.

Dr. Bob Bell has over 40 years of experience in the system as an orthopaedic surgeon, hospital president and top bureaucrat. Bell warned that centralization is a major undertaking for any government, but for a new government in particular it could be rife with problems.

To put the size of the task in perspective, Bell pointed out that the much smaller undertaking of merging Ontario’s Community Care Access Centres into the Local Health Integration Networks took approximately two years.

That merger, Bell contends, amounts to less than 10 per cent of the change that the government is now contemplating.

On top of that, he said the often stated goal of improving care is at best delayed while an “enormous” reorganization takes priority. For example, he said the transition in Alberta was marked by “chaos” in management and improvements to frontline care “stalled” while the new organization tried to find its legs.

The experience, he said “has been overwhelmingly negative for a long period of time.”

Nova Scotia had a similar experience when it amalgamated its health authorities in 2012, according to Dalhousie University Professor Katherine Fierlbeck.

“As a province goes through the turmoil of a huge overhaul, all hands are on deck trying to figure out what the administrative changes are,” she said. In the case of Nova Scotia she said that for about four years other work was “put on hold” until the restructuring was figured out.

The result was that wait lists for family doctors ballooned and primary care was left in “shambles.”

“The attempt to figure out how a huge new system works is labour-intensive, time-consuming, and frustrating,” she said.

Despite the experiences in other parts of Canada, Elliott said Ontario would avoid those pitfalls by doing its due diligence.

“The implementation will be considered in every detail to make sure that we do this right,” she said. “We owe this to the people of Ontario. That’s why we were elected and that’s what we are going to deliver to them: better quality, responsive, transformative health care.”

On top of the potential for frontline care to worsen, Bell said he’s also concerned that during major reorganizations patients who are already receiving care can fall through the cracks.

“I worry for patients,” he said. For example, pointing to the 750,000 Ontarians who receive home care currently through LHINs but that will have to be transferred to a new system.

Elliott immediately shot down those concerns.

“Neither Dr. Bell, nor the people of Ontario need to be worried about that. We are absolutely concerned with making sure that everyone in Ontario receives the services that they need.”

To avoid repeating history, Steven Lewis, a Canadian health policy consultant and adjunct professor at Simon Fraser University, said the Ford government will have to make sure that it gets buy-in for its plan from frontline staff.

The general experience of health care amalgamations “has been the declaration of grand ambitions to transform health care, none of which was realized,” he said over email from his current posting in Australia.

“The aspirations were doomed for a few reasons, but probably the most important was that the new structures didn’t include physicians,” Lewis said.

A big reason for that is that, while funding flows through the super agency, it’s the province that negotiates the contracts with physicians. Those agreements, he said, are short on accountability and the majority still focus on volume when measuring performance, and don’t include other important measurements like health outcomes.

On that score, he said, Ontario has pushed the furthest ahead by introducing family health teams, but overall it’s not enough. For example, Lewis points out that variation and inconsistencies in practice lead to as much as 30 per cent of health care being either “harmful or useless.”

For an amalgamation to be successful, Lewis said issues like that have to be tackled on top of the questions about how the super agency should be organized.

“New structures may be necessary to achieve lofty performance goals but they are hardly sufficient,” he concluded. “When in doubt, Canada reorganizes, because it is easier than real change and looks like something is being done. We’ll see if Ontario has learned this lesson if it goes down the restructuring road one more time.”